AME HIMS AME & Special Issuance Processes 2 — Questions and Answers
Question 1: What laboratory tests does the FAA typically require as part of the initial HIMS evaluation package for an airman with alcohol use disorder?
- Complete blood count (CBC) only
- CBC, comprehensive metabolic panel, liver function tests, carbohydrate-deficient transferrin (CDT), and urinalysis (Correct answer)
- Only BAC testing at the time of the exam
- Liver biopsy and genetic alcohol metabolism testing
Correct answer: CBC, comprehensive metabolic panel, liver function tests, carbohydrate-deficient transferrin (CDT), and urinalysis
The HIMS alcohol evaluation package typically includes comprehensive liver function tests and CDT - a glycoprotein marker of chronic heavy alcohol use - along with CBC and metabolic panel to assess alcohol-related organ damage.
Carbohydrate-deficient transferrin (CDT) is a glycoprotein that becomes abnormally glycosylated with sustained heavy alcohol consumption. It is a relatively specific marker for chronic heavy drinking and is used in HIMS evaluations to provide objective evidence of alcohol use beyond self-report. The complete HIMS laboratory panel typically includes CBC for macrocytosis and thrombocytopenia; comprehensive metabolic panel; liver function tests including AST, ALT, GGT, alkaline phosphatase, and bilirubin; CDT; and urinalysis including microscopy.
Question 2: An airman with a history of coronary artery bypass graft surgery presents for AASI re-issuance. Their blood pressure today reads 162/100 and they admit to stopping their medication 2 months ago. What must the AME do?
- Issue the certificate; the Authorization is still active
- Defer to AMCD - the airman no longer meets the Authorization's specified criteria for issuance, and the case requires AMCD review (Correct answer)
- Issue with a lower certificate class (Third-Class) until BP is controlled
- Ask the airman to restart their medication and return in 2 weeks
Correct answer: Defer to AMCD - the airman no longer meets the Authorization's specified criteria for issuance, and the case requires AMCD review
When an AASI applicant no longer meets the criteria specified in their Authorization, the AME cannot issue under AASI and must defer to AMCD with full documentation of the current non-compliance.
AASI issuance authority is conditional on the applicant meeting all criteria specified in the Authorization. When the airman stops their antihypertensive medication and presents with uncontrolled BP, they no longer meet the criteria that supported the original Authorization. The AME must document the non-compliance and current BP readings, deny issuance, and defer to AMCD with full documentation. The airman must reinitiate treatment, demonstrate controlled BP, and have the AMCD review whether the original Authorization can be reinstated.
Question 3: For an airman with insulin-treated Type 1 diabetes seeking Special Issuance Authorization for Third-Class certification, what monitoring requirements does the FAA typically mandate?
- Monthly HbA1c testing and annual ophthalmology exam
- Continuous glucose monitoring (CGM) or frequent SMBG before and during flight, HbA1c within target range, no hypoglycemic episodes, cardiac and ophthalmic evaluations, and regular endocrinology follow-up (Correct answer)
- No additional monitoring beyond the standard FAA medical exam requirements
- Weekly fasting glucose measurement reported to the AMCD
Correct answer: Continuous glucose monitoring (CGM) or frequent SMBG before and during flight, HbA1c within target range, no hypoglycemic episodes, cardiac and ophthalmic evaluations, and regular endocrinology follow-up
The FAA's insulin-treated diabetes Authorization protocol for Third-Class requires comprehensive glucose monitoring during flight, absence of hypoglycemic events, and periodic specialist evaluations to manage the complex risks of hypoglycemia in flight.
The FAA's Special Issuance protocol for insulin-dependent diabetes mellitus requires a comprehensive monitoring program reflecting the primary safety concern of hypoglycemia-induced incapacitation. Requirements typically include CGM use or frequent SMBG before flight, every 30 minutes during flight, and within 30 minutes of landing; blood glucose at or above 100 mg/dL before flight with glucose supplement protocol if approaching threshold; no hypoglycemic episodes with altered consciousness in the prior 3 months; HbA1c within specified range; annual cardiology evaluation; annual ophthalmology evaluation for diabetic retinopathy; and renal function testing.
Question 4: A First-Class applicant discloses treatment for depression 3 years ago with escitalopram, which was discontinued after 1 year with full remission and no recurrence. What is the correct certification approach?
- Deny issuance; any prior antidepressant use is permanently disqualifying for First-Class
- Defer to AMCD with a current psychiatric evaluation report confirming full remission (Correct answer)
- Issue standard First-Class certificate; remitted depression with no current medication is not disqualifying
- Issue under SSRI AASI; prior SSRI use requires AASI regardless of current medication status
Correct answer: Defer to AMCD with a current psychiatric evaluation report confirming full remission
Any history of major depression, even in full remission with no current medications, requires AMCD evaluation with a current psychiatric report before First-Class certification can proceed.
A history of major depressive disorder even with full remission and medication discontinuation requires the AME to defer to AMCD for Authorization with a current psychiatric evaluation report. The psychiatric evaluation must confirm full clinical remission, no recurrence during the observation period, no functional impairment, and a favorable psychiatric prognosis. The FAA does not automatically disqualify applicants with remitted depression, and many receive Authorization. However, the determination requires psychiatric expertise, and standard issuance without AMCD review is not appropriate for any psychiatric history.
Question 5: What is the purpose of the MMPI-2 (Minnesota Multiphasic Personality Inventory-2) in the FAA HIMS evaluation?
- It measures IQ and cognitive performance in recovering substance users
- It is a standardized psychological assessment of personality structure and psychopathology, used in HIMS evaluations to identify psychological factors affecting recovery and flight fitness (Correct answer)
- It assesses specific aviation skill retention after a period of grounding
- It is used only for applicants with both substance use and psychiatric comorbidities
Correct answer: It is a standardized psychological assessment of personality structure and psychopathology, used in HIMS evaluations to identify psychological factors affecting recovery and flight fitness
The MMPI-2 is a comprehensive standardized psychological test measuring personality characteristics and psychopathology, used in HIMS evaluations to provide objective psychological assessment of the airman's mental fitness and recovery stability.
The MMPI-2 is a 567-item self-report psychological instrument that measures a broad range of personality characteristics, psychological functioning, and psychopathological constructs across 10 clinical scales plus validity scales and supplementary scales. In HIMS evaluations, the MMPI-2 provides objective, standardized data on psychological constructs relevant to recovery and flight fitness: antisocial personality traits, denial tendencies, impulse control, emotional stability, and psychopathological comorbidities. It is generally administered by a HIMS-qualified psychologist or psychiatrist as part of the comprehensive evaluation package.
Question 6: When a Third-Class medical certificate holder's certificate expires while they are mid-flight, what are the regulatory implications?
- The pilot may complete the current flight and then must ground themselves until recertification
- The pilot was already in violation if they began the flight after the certificate had expired; in-flight expiration during a flight that was legal at departure is an administrative matter (Correct answer)
- The pilot must land immediately at the nearest airport upon expiration
- There are no implications - medical certificates expire at midnight and flights typically end before then
Correct answer: The pilot was already in violation if they began the flight after the certificate had expired; in-flight expiration during a flight that was legal at departure is an administrative matter
14 CFR 61.23 requires a valid medical certificate to exercise pilot privileges. If the certificate expires in flight, the pilot violated no regulation if the certificate was valid at flight commencement; the obligation was fulfilled at takeoff.
14 CFR 61.23(a) requires airmen to hold the appropriate medical certificate when exercising pilot privileges. The relevant legal moment is when the flight begins. If a valid medical certificate existed at flight commencement, the pilot has met the regulatory requirement for that flight. Mid-flight expiration does not create a regulatory violation for the current leg. However, the pilot must not begin any subsequent flight without a valid certificate. AMEs should counsel applicants to schedule renewal exams well in advance of expiration to avoid any gaps in certification.
AME HIMS AME & Special Issuance Processes 2
What laboratory tests does the FAA typically require as part of the initial HIMS evaluation package for an airman with alcohol use disorder?